Provider Demographics
NPI:1215264338
Name:DAVIS, AVERY L (MA, LPC)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 S LOGAN ST STE D
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3700
Mailing Address - Country:US
Mailing Address - Phone:720-440-2080
Mailing Address - Fax:719-269-9386
Practice Address - Street 1:950 WADSWORTH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4542
Practice Address - Country:US
Practice Address - Phone:720-440-2080
Practice Address - Fax:720-664-2162
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COLPC.0011413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health